graspa (erythrocytes encapsulating l-asparaginase) in patients with relapse of acute lymphoblastic leukemia

Conditions: Acute Lymphoblastic Leukemia, in Relapse

Summary: asparaginase is a cornerstone in the treatment of all, but its utility is limited by toxicities including hypersensitivity. clinical allergy is associated with inactivation of asparaginase by antibodies (a-abs), which can also neutralize asparaginase without any clinical signs of hypersensitivity (silent inactivation). graspa improves pharmacokinetics, tolerability and maintain circulating asparaginase activity due to the protective barrier of the erythrocyte membrane. this study is run to confirm the benefit/risk profile of graspa at 150 iu/kg in combination with the cooprall regimen in adults and children patients with relapsed all, with or without known hypersensitivity to l-asparaginase.

this open, randomized international phase 2/3 study will enrol patients with relapsed all. the co-primary endpoints were the duration of asparagine depletion \< 2µmol/l and the incidence of asparaginase hypersensitivity during induction. key secondary endpoints are complete remission (cr), minimal residual disease (mrd), event free survival (efs) and overall survival (os).the study was powered to detect 3-fold difference in the incidence of allergic reactions between treatments. patients will be randomized to graspa or to reference l-asparaginase. patients with history of hypersensitivity to previous l-asparaginase treatment will be treated with graspa (exploratory arm)

Eligibility criteria:
inclusion criteria: * patient from 1 to 55 years old (children and adolescents from 1 to 17 years/ adults from 18 to 55 years) * patients with 1st all relapse, which could be either isolated bone marrow relapse, or combined (medullary and extra-medullary) relapse, or extra-medullary isolated relapse; or lymphoblastic lymphoma (excepted burkitt lymphoma) or failure to all first line treatment (no complete remission obtained) * patient previously treated with free e.coli l-asparaginase form or pegylated one * performance status ≤ 2 (who score) * patient informed and consent provided (the 2 parents need to consent when children are below 18) exclusion criteria: * all t(9;22) and/or bcr-abl positive (philadelphia chromosome positive) * patient with 2nd relapse and over * women of childbearing potential without effective contraception as well as pregnant or breast feeding women * patient unable to receive treatments used in global chemotherapy protocols, due to general or visceral conditions such as:severe cardiac impairment (nyha grade 3 or 4 cardiomyopathy)/serum creatinine 2 x uln unless related to all /alt or ast 5 x uln unless related to all /pancreatitis history /other malignancy that all / severe infection, hiv positive, active hepatitis related to b or c virus infection / trisomy 21 / other serious conditions according to investigator's opinion * known grade 4 allergic reaction to e.coli l-asparaginase (according nci-ctcae, version 3.0) * history of grade 3 transfusional incident * presence of specific anti-erythrocyte antibodies preventing from getting a compatible erythrocyte concentrate for the patient * patient under concomitant treatment likely to cause hemolysis * patient undergoing yellow fever vaccination * patient under phenytoin treatment * patient included in previous clinical study less than 6 weeks ago

Keywords: acute lymphoblastic leukemia relapse asparaginase